Abdominal wall abscess containing gallstones as a late complication to laparoscopic cholecystectomy performed 17 years earlier

Abstract

Laparoscopic cholecystectomy (LC) is the preferred surgical treatment for symptomatic gallstones. The laparoscopic procedure is superior to the open approach in many aspects. Intraperitoneal spillage of bile and gallstones is one of the most common accidental occurrences of LC. We present a case of a 53-year-old woman who developed two abscesses­—one intra-abdominally and one in the abdominal wall—17 years after an LC. Three gallstones were found during surgical excision of the abdominal wall abscess. Surgeons should strive to avoid perforation of the gall bladder during LC. If spillage is inevitable attempts should be made to laparoscopically extract as many stones as possible. Documentation of (suspected) spillage is paramount when evaluating the possibility of postoperative complications, even many years later.

Spilled Gallstones Silent for a Decade: A Case Report and Review of Literature

“…concluded that out of 129 cases of gallstone spillage, the conservative open approach had only two cases of this subsequent complication [ 2 ]. An array of various factors subsequently disposes to perforation such as the dissection of the gallbladder from the liver bed, the application of undue retraction of the gallbladder via forceps, as well as gallbladder extraction, which can also potentiate spillage [ 3 ].…”

“…As illustrated, the risk of perforation and spillage is high [ 1 ]. However, the subsequent development of actual complications secondary to a stone spillage is relatively rare, with an estimated incidence of 0.8%-8.5% [ 3 ]. This alludes to the understanding that certain risk factors influence the possibility of developing complications.…”

“…Pigmented stones and nonsterile bile contain infective pathogens, and the presence of either subsequently enhances the risk of abdominal abscesses [ 1 ]. It is for these reasons that most abscesses contain the same flora as that of an infected gallbladder, such as Escherichia coli [ 3 ]. Our patient presented with an abdominal abscess after a laparoscopic cholecystectomy, which was performed more than 10 years ago.…”

“…A subsequent infection of the calculus and its adjacent vicinity may lead to a localized inflammatory response, which consequently leads to the formation of an abdominal abscess [ 6 ]. Another postulation considers the presence of an insulative plate around the stone, which gradually deteriorates over time and, subsequently, predisposes the stone to an infection and resultant abscess formation [ 3 ]. A literature review conducted on 91 patients by Brockman et al.…”

Unusual aetiology of abdominal wall abscess: cholecystocutaneous fistula presenting 20 years after open subtotal cholecystectomy

“…This can happen many years after surgery, for example, in the case of a patient who presented with painful defecation due to an abscess in the pouch of Douglas, and was also found to have a small asymptomatic chronic anterior abdominal wall abscess 10. Gallstones have also been reported to lodge in the anterior abdominal wall during port removal after laparoscopic cholecystectomy—either at the level of the rectus sheath or internal oblique muscle—and to cause abscess formation up to 8 years after operation 11 12…”